VIRTUAL: Tobacco Use, Opioids, and Pain: Exploring the Connections

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Description: This workshop will provide the latest information on why tobacco/nicotine use is often so intertwined with opioid use disorder. Nicotine and opioid addictions are mutually reinforcing (they enhance and support each other’s effect on the brain) for a variety of reasons. Tobacco/nicotine use has an impact on how an individual experiences pain and treats painful conditions. It is also a strong predictor of opioid misuse. Nine in ten individuals in treatment for opioid use disorder are also tobacco/nicotine users. In this session we will explore the biological, psychological, and social connections between tobacco/nicotine use and pain, addiction, and recovery. Nicotine and opioids impact the same neuropathways in the brain, which is why nicotine may enhance the “feel good” properties of opioids. This is also why quitting tobacco/nicotine use is associated with long-term abstinence following treatment for opioid use disorder. 

There is a significant association between tobacco/nicotine use and pain. Nicotine has some pain-relieving properties that, at first, can help relieve acute pain. However, over time tobacco/nicotine use can cause structural changes in the body that lead to painful conditions, like muscle or bone damage, weakened spine, joint disorders, and arthritis. Smoking can lead to the increased prevalence and severity of many painful conditions, such as fibromyalgia, arthritis, pregnancy-related pelvic pain, oral pain, and HIV-related bodily pain. Smokers tend to use substantially more pain medications to treat these conditions than nonsmokers. Individuals who use tobacco/nicotine and take prescription opioid medications are at heightened risk for opioid use disorder. We will review why people with substance use disorders and mental health conditions have higher prevalence rates of tobacco/nicotine use than the general population and how this can be exacerbated by painful, co-occurring conditions.  We will outline the ways in which tobacco/nicotine use is biologically intertwined with pain and how it is often used to cope with the psychological effects of painful conditions. Nicotine addiction may interfere with the body’s natural pain receptors throughout the central nervous system, leading to greater pain and tolerance to opioid medications. 

We will also discuss new health risks that have surfaced in the past year related to cigarette smoking, e-cigarette use, and opioid use disorder, such as Covid-19. Data continues to emerge throughout the COVID-19 pandemic showing that both adults and youth who smoke or vape are at higher risk for contracting COVID-19 and may have more severe illness compared to people who do not smoke or vape. Additionally, individuals with opioid use disorder are at heightened risk for contracting COVID-19 and for complications from the disease. 

Participants can expect to receive the latest information on resources for helping people who may be ready to stop tobacco use and those interested in reducing risks as a step toward quitting in the future. We will discuss how to use motivational interviewing principles to integrate the topic of tobacco/nicotine use into the treatment of substance use and mental health disorders. We will also discuss how to talk with individuals who are not interested in making a change in their tobacco/nicotine use in a way that meets them where they are.

Learner Outcomes/ Behavioral Objectives:

  • Participants will describe 5 reasons for addressing tobacco use in opioid use disorder treatment
  • Participants will examine how to integrate the topic of tobacco/nicotine into their current work with clients
  • Participants will discuss interactions between tobacco/nicotine use and opioid use
  • Participants will be able to describe how tobacco/nicotine use increases the severity and duration of painful conditions
  • Participants will examine how opioid use disorder increases the risk of complications from COVID-19
  • Participants will identify new skills and strategies for discussing the overlap of smoking and vaping tobacco and COVID-19 symptoms and disease progression with clients
  • Participants will gain multiple strategies for introducing and integrating tobacco/nicotine awareness activities into substance use treatment


Substance use treatment counselors/clinicians and clinical supervisors, especially those working in opioid use disorder treatment programs; recovery support services staff and coaches; and others interested in learning about this topic

Kristina Fenn Silver, M.A.
Event Date: 
Thursday, October 21, 2021 - 9:00am to 12:00pm
Attendance Mode: 
Tobacco Education and Treatment
Contact Information
Emelie Trayah
AdCare Educational Institute, Inc.
Training Coordinator

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